Journal of Oral Rehabilitation
Journal of Oral Rehabilitation 2013 40; 686--692
Review Article
Face-bow transfer in prosthodontics: a systematic review of
the literature
A. FARIAS-NETO, A. H. M. DIAS, B. F. S. DE MIRANDA & A. R. DE OLIVEIRA
Health School, Potiguar University Laureate International Universities, Natal, Brazil
SUMMARY An extensive search for randomised
controlled clinical trials was accomplished to
compare dental prostheses and occlusal splints
constructed with or without face-bow transfer, and
question whether face-bow transfer may present
better clinical results than simpler approaches.
Studies were identified by searching electronic
databases (PubMed/MEDLINE, Latin American and
Caribbean Literature on the Health Science, and
Brazilian Bibliography of Dentistry). The keywords
dental articulator, semi-adjustable articulator,
face-bow, jaw relation record and occlusal splint
therapy were used. The minimum inclusion
requirements were (i) randomised controlled trials
with patients of any age, (ii) comparison between
dental prostheses or occlusal splints constructed
with or without face-bow transfer and (iii)
assessment of clinicians time, number of occlusal
Introduction
During prosthodontic treatment, it is important for
both the dentist and the dental technician to con-
struct indirect restorations that are well fitted in
patients masticatory system in a minimum amount of
time and effort. The face-bow has been regarded as
an indispensable accessory of semi-adjustable articula-
tors for transferring the maxillary cast. When the
face-bow is used, maxillary and mandibular casts are
mounted in relation to the temporomandibular joints
and in close proximity to the condylar hinge axis. This
may result in more accurate occlusal contacts in cen-
tric and eccentric positions. Brotman (1) used applied
2013 John Wiley & Sons Ltd
contacts, patient satisfaction or masticatory
function. The search resulted in the identification
of 8779 articles. Subsequently, 8763 articles were
excluded on the basis of title and abstract. By the
end of the search phase, eight randomised
controlled trials were considered eligible. Current
scientific evidence suggests that face-bow transfer
is not imperative to achieve better clinical results
in prosthodontics. Randomised clinical trials
suggest that simpler approaches for the con-
struction of complete dentures and occlusal splints
may present acceptable results, while no clinical
study has investigated its use in fixed and
removable partial dentures.
KEYWORDS: face-bow, dental articulator, complete
denture, prosthodontics, occlusal splint
Accepted for publication 15 June 2013
mathematics to show that occlusal errors are intro-
duced when the patients condylar hinge axis is not
properly located. Most prosthodontic textbooks have
stated that a face-bow record is necessary for orient-
ing the maxillary cast to the articulator for all types of
prosthetic work (2). A survey of forty-three U.S. den-
tal schools conducted in 2001 to determine the curric-
ular structure, teaching philosophies and techniques
used in pre-clinical complete denture courses revealed
that the face-bow is used by 84% of the schools (3).
In Ireland and United Kingdom, 10 of the 12 dental
schools surveyed on the undergraduate teaching of
fixed partial dentures required the use of a face-bow
to mount the maxillary cast within the articulator (4).
doi: 10.1111/joor.12081
 FACE-BOW TRANSFER: AN EVIDENCE BASED APPROACH
However, it has never been scientifically docu-
mented that the most sophisticated and complicated
methods for jaw relation recording and construction
of dental prostheses lead to better clinical results.
Kawai et al. (5). compared the quality of 122 con-
ventional complete dentures fabricated with tradi-
tional or simplified techniques. No difference was
found for patient overall satisfaction and prosth-
odontists ratings of denture quality. In 1991, the
Scandinavian Society for Prosthetic Dentistry (SSPD)
presented a consensus publication stating that a
face-bow is not necessary and recommended simple
methods in jaw recording for all types of prosth-
odontic work (2).
As the value of the face-bow remains questionable,
the purpose of this study was to accomplish an exten-
sive search for randomised controlled clinical trials
comparing dental prostheses and occlusal splints con-
structed with or without face-bow transfer. The
research hypothesis was that the construction of den-
tal prostheses and occlusal splints with face-bow
transfer may present better clinical results than sim-
pler approaches.
Materials and methods
Information sources
Studies were identified by searching electronic databases.
The keywords dental articulator, semi-adjustable
articulator, face-bow, jaw relation record and
occlusal splint therapy were used. No limits were
applied for language. This search was applied to
PubMed/MEDLINE, LILACS (Latin American and
Caribbean Literature on the Health Science) and BBD
(Brazilian Bibliography of Dentistry). Additional refer-
ences from citations within the articles were obtained,
and current textbooks were also used. Papers dated
between 1950 and 2013 were selected. The last search
was run on 8 March 2013.
Inclusion and exclusion criteria
The minimum inclusion requirements were (i) rando-
mised controlled trials with patients of any age, (ii)
comparison between dental prostheses or occlusal
splints constructed with or without face-bow transfer
and (iii) assessment of clinicians time, number of
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687
occlusal contacts, patient satisfaction or masticatory
function. Clinical reports, reviews and short commu-
nications were excluded.
Review methods
All reports identified by the search were printed and
independently analysed once by each of the two
reviewers on the basis of title, keywords and abstract
(when available) to check if the study was likely to be
relevant. Full reports of all relevant papers and all
papers that could not be classified were obtained. In
cases of disagreement, a third reviewer was consulted
to achieve consensus. The reviewers were not blinded
as to authors, journals, date of publication, financial
support or results. The inclusion criteria were applied,
data assessed and then independently extracted by
two reviewers. Consensus was sought in cases of dis-
crepancy.
Results
The search resulted in the identification of 8779 stud-
ies. Subsequently, 8763 articles were excluded on the
basis of title and abstract mostly because they did not
investigate the use of the face-bow and were laborato-
rial studies or review articles. Two studies identified
by the hand search were excluded because they were
master thesis. The full texts of 14 studies were
screened. During full-text screening, six articles were
excluded because they did not meet the inclusion cri-
teria for assessment of clinician time, number of
occlusal contacts, patient satisfaction or masticatory
function. By the end of the search phase, eight rando-
mised controlled trials were considered eligible
(512). Their data were the basis of this review
(Table 1). Figure 1 is a flow chart of studies assessed
and excluded at various stages of the review. Of the
seven studies regarding complete denture construc-
tion, three studies presented no difference between
simpler and complex approaches, while four studies
presented better results for the simpler approach with-
out the face-bow. One study investigated the use of
the face-bow in occlusal splints, but no difference was
found regarding the number of occlusal contacts and
the time needed for chairside occlusal adjustment. No
clinical study was found regarding fixed and remov-
able partial dentures.
688 A . F A R I A S - N E T O et al.

Table 1. Randomised clinical trials evaluating the influence of face-bow transfer on prosthodontic work

Author Study design Outcomes Results

Ellinger et al. (6) Complete denture Coincidence of centric relation No difference

Single-blinded study with centric occlusion, denture
n = 64 stability, denture retention,
Age: <65 years condition of the supporting
Inclusion criteria: patients edentulous for tissues
a period of at least 1 year
Exclusion criteria: not mentioned
Shodadai et al. (7) Occlusal splint Number of intraoral No difference
n = 20 occlusal contacts and the
Age: not mentioned time needed for chairside
Inclusion criteria: adult patients with a occlusal adjustment
complete natural dentition who had been
diagnosed with dental attrition because of
nocturnal bruxism
Exclusion criteria: not mentioned
Nascimento et al. (8) Complete denture Number of occlusal Better patient satisfaction
Double-blinded study contacts and patient and greater number of
n = 5 (crossover design) satisfaction occlusal contacts in
Age: not mentioned centric relation and left
Inclusion criteria: not mentioned lateral movement
Exclusion criteria: not mentioned without the face-bow
Kawai et al. (5) Complete denture Patient satisfaction No difference
Single-blinded study regarding overall
n = 122 satisfaction, comfort,
Age range: 4575 years stability, aesthetics,
Inclusion criteria: subjects were eligible if they ability to speak, ease of
were aged between 45 and 75 years, cleaning and ability to
edentulous, had significant problems with at chew soft white bread,
least one of their existing dentures, possessed hard cheese, raw carrot,
an adequate understanding of written and sausage, steak, raw apple
spoken French and were able to understand and lettuce (VAS)
and respond to a test questionnaire
Exclusion criteria: symptoms of
temporomandibular disorders, xerostomia,
oro-facial motor disorders, severe oral
manifestations of systematic disease or
psychological or psychiatric conditions that
could influence their response to treatment
Heydecke et al. (9) Complete denture Patient satisfaction The ability to chew in
Single-blinded study regarding aesthetic general and to masticate
n = 22 (crossover design) appearance, ability to carrots, hard sausage,
Age range: 5085 years chew, ability to speak steak and raw apple was
Inclusion criteria: patients requiring a new set and retention (VAS) significantly better
of dentures and able to read and respond to without the face-bow
a written questionnaire in German
Exclusion criteria: symptoms of
temporomandibular disorders, xerostomia,
oro-facial motor disorders, severe oral
manifestations of systematic diseases or
psychological or psychiatric conditions that
could influence their response to treatment

(continued)

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 FACE-BOW TRANSFER: AN EVIDENCE BASED APPROACH 689

Table 1. (continued)

Author Study design Outcomes Results

Heydecke et al. (10) Complete denture General satisfaction, Patients rated their
Single-blinded study comfort, ability to speak, general satisfaction,
n = 20 (crossover design) denture stability, denture stability and
Age range: 5085 years. aesthetics, ease of aesthetic appearance
Inclusion criteria: patients requiring a new set cleaning and ability to significantly better
of dentures and able to read and respond to chew (VAS) without the face-bow
a written questionnaire in German
Exclusion criteria: symptoms of
temporomandibular disorders, xerostomia,
oro-facial motor disorders, severe oral
manifestations of systematic diseases or
psychological or psychiatric conditions that
could influence their response to treatment
Kawai et al. (11) Complete denture Production cost and Mean total cost was
Single-blinded study clinicians labour time significantly greater and
n = 122 clinicians spent 90 min
Age: 4575 years longer on clinical care
Inclusion criteria: significant problems with at with the face-bow
least one of their existing dentures, possessed
an adequate understanding of written and
spoken French and were able to understand
and respond to a test questionnaire
Exclusion criteria: symptoms of
temporomandibular disorders, xerostomia,
oro-facial motor disorders, severe oral
manifestations of systematic disease or
psychological or psychiatric conditions that
could influence their response to treatment
Cunha et al. (12) Complete denture Masticatory performance No difference for
Single-blinded study (colorimetric method) masticatory performance;
n = 42 and chewing ability better masticatory ability
Age: >45 years without the face-bow
Inclusion criteria: complete edentulism for at
least 1 year, desire to receive a pair of new
conventional complete dentures, mental
receptiveness and good understanding of
spoken Portuguese
Exclusion criteria: disorders of the masticatory
system disorders, pathological changes of
residual ridges and debilitating systemic
diseases

face-bow transfer, while four studies presented no dif-

Discussion
The results of this study did not support the research
hypothesis that the construction of dental prostheses
and occlusal splints with face-bow transfer may pres-
ent better clinical results than simpler approaches. Of
the seven studies identified regarding complete den-
ture construction, three studies presented better
results when the dentures were constructed without
ference. One study regarding occlusal splint therapy
was identified, but no difference was found. No clini-
cal trials were identified regarding the construction of
removable partial dentures or fixed prosthodontics.
A classical longitudinal series of randomised clinical
trials initiated in 1969 investigated if clinical differ-
ences exist in dentures made using two different tech-
niques (6, 1316). The sample was composed by 64

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690 A . F A R I A S - N E T O et al.
Fig. 1. Studies assessed and excluded at various stages of the review.
edentulous patients divided into two groups. The vari-
ables investigated were denture quality (6), residual
ridge resorption (14,15) and microscopic status of the
oral mucosa (16). The complex technique involved
location of the true hinge axis for a face-bow transfer
to mount the upper cast on a semi-adjustable articula-
tor. The lower cast was mounted in centric relation.
Eccentric records were made. The denture teeth were
arranged and adjusted to a fully balanced occlusion.
The standard technique involved no face-bow trans-
fer. All dentures were constructed by five experienced
prosthodontists. Ellinger et al. (6). evaluated denture
quality at the initial placement appointment and five
yearly recall visits. No difference was found for coinci-
dence of centric relation with centric occlusion, den-
ture stability, denture retention and condition of the
supporting tissues. Furthermore, no difference was
found for ridge resorption (14, 15) and mucosal status
(16).
Kawai et al. (5) conducted a randomised clinical trial
with 122 patients randomly allocated into two groups
according to a classical or a simplified technique for
the construction of complete dentures. In the classical
protocol, dentures were made following preliminary
impression, final impression with a custom tray and
border moulding with impression compound, occlusal
registration, face-bow transfer, try-in, delivery and
adjustments. In the simplified technique, a single
impression with a stock tray and alginate was used,
while no face-bow transfer was accomplished. All
dentures were constructed by two experienced prosth-
odontists. Patients ratings on a 100-mm visual ana-
logue scale (VAS) for overall satisfaction, comfort,
stability, aesthetics, ability to speak, ease of cleaning,
and ability to chew soft white bread, hard cheese, raw
carrot, sausage, steak, raw apple and lettuce were eval-
uated at 3 and 6 months post-insertion. The quality of
the dentures was assessed by one prosthodontist. No
significant difference in patient satisfaction or in the
perceived quality of conventional dentures produced
with classical or simplified techniques was found.
Multiple regression analysis revealed no effect of
potential confounders (age, gender, diagnostic classifi-
cation, edentulous period and treating prosthodontist)
on general satisfaction. A similar protocol was adopted
by Cunha et al. (12) in a randomised clinical trial with
42 subjects. The authors reported no impairment in
masticatory performance and patients satisfaction
regarding masticatory function after 3 months. Fur-
thermore, Kawai et al. (11) compared the laboratorial
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 FACE-BOW TRANSFER: AN EVIDENCE BASED APPROACH
costs and clinicians labour time between both meth-
ods. The simplified technique decreased laboratorial
costs and clinicians time (90 min less). However, this
reduction was influenced by both the single impression
and the maxillomandibular recording.
In the studies conducted by Heydeckes group (9,
10), the influence of face-bow transfer and occlusal
concept on general satisfaction, comfort, ability to
speak, stability, aesthetics, ease of cleaning and ability
to chew was evaluated. Twenty subjects wore two sets
of complete dentures for equal periods of 3 months.
One set was constructed with individualised condylar
inclination recorded using a face-bow and extraoral
tracings, and teeth arranged in balanced occlusion.
The other set was made using a simplified method
without face-bow transfer and canine/first pre-molar
guidance. Dentures were constructed by three prosth-
odontists and a dental technician. VAS measures for
general satisfaction, stability and aesthetics were sig-
nificantly better for the simplified method. No differ-
ence was found for ability to speak, comfort, ability to
chew and the ease of cleaning the dentures (9). Fur-
thermore, chewing ability was rated more favourably
with the simplified method for carrots, hard sausage,
steak and raw apple (10). At the end of the study,
patients were asked to choose one set of dentures.
Five subjects preferred the complex method, 12 pre-
ferred the simplified method and three patients had
no preference (9).
A potential limitation of the studies evaluating the
clinical benefits of face-bow transfer in complete den-
ture is the involvement of other variables. Of the
seven studies identified, the simplified method also
included a single impression or a different occlusal
concept in six of them. Only the study of Nascimento
et al. (8). investigated exclusively the influence of
face-bow transfer in the construction of complete
dentures. The authors reported that a balanced occlu-
sion was achieved even without face-bow transfer
and could be an alternative to obtain adequate com-
plete dentures. However, that study presented a lim-
ited sample of five subjects (crossover design) and
10 days of follow-up. Furthermore, in all clinical trials
included in this systematic review, dentures were
constructed by experienced clinicians or prosthodon-
tists. The question is whether undergraduate students
may achieve similar results using the simplified
method. If so, should we shorten the time devoted for
the teaching of face-bow transfer and enhance the
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691
practice of more critical procedures? More studies are
necessary to test the clinical results of simplified
methods when conducted by undergraduate students.
A randomised clinical trial was conducted to evalu-
ate the influence of face-bow transfer on the number
of intraoral occlusal contacts and the time needed for
chairside occlusal adjustment of occlusal splints (7).
The sample consisted of 20 fully dentate adult patients
diagnosed with bruxism. For each patient, two occlu-
sal splints made of acrylic resin were constructed suc-
cessively by the same experienced dental technician
using the same articulator. One of the occlusal splints
was constructed by transferring the upper dental cast
to the articulator with the face-bow, while the other
occlusal splint was constructed by arbitrarily mount-
ing the maxillary cast with the help of a flat occlusal
plane indicator. Bennett angle was set to 15, and
condylar inclination was adjusted to 45. The two
splints were inserted and adjusted in random order.
Clinical outcomes did not differ between the two
occlusal splints. The authors suggested a combination
of factors to explain why patients may not benefit
from face-bow transfer: change (usually increase) of
the occlusal vertical dimension after making the cen-
tric relation interocclusal record; lack of evidence for
pure condylar rotation and the existence of a condylar
hinge axis on mandibular opening; unpredictable and
variable condylar movements on mandibular opening;
use of rigid hinge axis articulators; and the presence
of temporomandibular pain.
To summarise, the results of this systematic review
suggest that there is no scientific evidence to support
the use of the face-bow during the construction of
complete dentures and occlusal splints. Randomised
clinical trials have shown that simpler approaches for
the construction of complete dentures and occlusal
splints may present similar results to more complex
techniques. Furthermore, there is a lack of clinical
studies evaluating the use of the face-bow in fixed
prosthodontics and removable partial dentures. It has
been argued that the face-bow is essential for produc-
ing consistently predictable aesthetic restorations,
because the casts must be oriented on the technicians
bench in the same horizontal plane as the crowns will
be when they are placed in the patients mouth. More
studies are necessary to clarify the importance of face-
bow transfer, because simpler approaches may facili-
tate the access to prosthodontic services and influence
undergraduate dental curriculum.
692 A . F A R I A S - N E T O et al.
Conclusion
Current scientific evidence suggests that face-bow
transfer is not imperative to achieve better clinical
results in prosthodontics. Randomised clinical trials
suggest that simpler approaches for the construction
of complete dentures and occlusal splints may present
acceptable results, while no clinical study has investi-
gated its use in fixed and removable partial dentures.
Disclosure/Acknowledgments
We declare no conflict of interest. This research was
carried out without funding.
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Correspondence: Arcelino Farias-Neto, Health School, Potiguar
University Laureate International Universities, Av. Sen. Salgado
Filho, 1610 Lagoa Nova, 59056-000 Natal, RN, Brazil.
E-mail: arcelino.farias@unp.edu.br
2013 John Wiley & Sons Ltd
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